Escaping the catch 22 of lupus anticoagulant testing

Pernille Just Vinholt, Søren Andreas Just*

*Corresponding author for this work

Research output: Contribution to journalComment/debateResearchpeer-review

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Abstract

High-risk patients with antiphospholipid syndrome (APS) experience increased risk of thrombosis when treated with direct oral anticoagulant (DOAC) therapy compared with warfarin. It is essential to establish the APS diagnosis to choose therapy and determine treatment duration. It requires testing for antiphospholipid antibodies, including lupus anticoagulant (LAC). In this viewpoint, we discuss the options for timing of LAC testing, which includes testing before starting anticoagulant treatment (DOAC or warfarin), after switching to heparin or after withdrawal of anticoagulant treatment. DOACs interfere with LAC testing and recommendations emerge stating not to conduct on-therapy LAC testing. All approaches are to some extent currently practised, but have limitations and the area is therefore seemingly a catch 22. We put forward that the anticoagulant effect of DOAC can be eliminated in the laboratory and therefore patients can be tested on-therapy. While it may not eliminate all cases of interference, it could aid the interpretation in these situations and this approach is attractive from the patient and clinician's perspective. Nevertheless, to prevent misdiagnosis the diagnostic workup for APS requires collaboration between the clinician and the laboratory. We advocate for standardisation in laboratory and clinical practice when diagnosing APS.

Original languageEnglish
Article numbere001156
JournalRMD Open
Volume6
Issue number1
Number of pages3
ISSN2056-5933
DOIs
Publication statusPublished - 5. Mar 2020

Keywords

  • antiphospholipid antibodies
  • antiphospholipid syndrome
  • cardiovascular disease
  • quality indicators

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